Substance use disorder (SUD) refers to the recurrent use
of alcohol and/or drugs that leads to health problems, disability, and failure to meet
major responsibilities at work, school, or home.

An estimated 2.15 million people in the United States - 9% of the population -
have a diagnosable substance use disorder (SUD). Epidemiological and
clinical studies suggest that SUDs follow a chronic, relapsing course,
with cycles of recovery, relapse, and multiple treatment episodes, over
the course of several years.

"According to SAMHSA (2015), alcohol and drug abuse and related
problems contribute substantially to the burden of disease in the U.S.,
costing an estimated $400 billion annually," said Dr. Jennifer Manuel, an assistant professor at the NYU Silver School of Social Work, and
an affiliated researcher with New York University's Center for Drug Use
and HIV Research (NYU CDUHR). "It is essential to reduce the cycle of
treatment for SUDs - both for public health and financial reasons."

‘Enhanced support post-discharge from residential treatment is critical to improve the quality of transitions and outcomes of individuals with substance use disorders.’

Long-term residential substance abuse treatment is a preferred
option for those seeking to recover from SUDs. "In-patient" treatment
provides intensive recovery-related services combined with safe housing
and assistance with daily living. However, relapse following discharge
is still common and can reverse or deplete improvements made during
treatment. According to the statistics, the rates of relapse within the
first year after discharge range from 37% to 56%.

Engagement in aftercare services has been shown to improve this
statistic. However research shows that only about half of patients make
initial contact with outpatient care, and very few complete recommended
duration of aftercare services.

In order to explore the factors that hinder and help individuals
transition from long-term residential substance abuse treatment centers
to the community, Dr. Manuel and her collaborators, Dr. Obie Nichols and
Ms. Erin Palmer, from Services for the UnderServed, Inc., (SUS)
conducted a qualitative socio-ecological model-based study, "Barriers
and Facilitators to Successful Transition from Long-Term Residential
Substance Abuse Treatment," the findings of which were recently
presented at the 2016 Alcoholism and Substance Abuse Providers of New
York State conference.

The research team focused on five barrier/facilitator categories:
individual, interpersonal, organizational, community, and policy. The
study is published on-line ahead of print in the Journal of Substance Abuse Treatment, December 2016.

"We know little about the transition barriers and facilitators from
long-term residential substance abuse treatment from the perspectives of
individuals with SUDs," notes Dr. Manuel. "Using the socio-ecological
model as a guiding framework, this study explores the individual,
interpersonal, organizational, community, and policy factors that impede
and facilitate the transition from residential substance abuse
treatment from the perspectives of individuals with SUDs who are
anticipating discharge from treatment."

The study consisted of semi-structured interviews (45-90 minutes in
length) with individuals (n=32) from a long-term residential substance
abuse treatment program (average length of stay is six months) in NYC.
Interviews were digitally recorded and subsequently transcribed.
Individuals received a $30 gift card for participating in the interview.
Participants ranged in age 23-55 years old; over three-fourths of the
participants were male. All but one participant was receiving Medicaid
benefits, with 56% of participants having been mandated to treatment.
Nearly all (90.6%) participants reported being jailed or incarcerated in
their lifetime; three-fourths reported being homeless in their
lifetime.

Common barriers to successful transition:

- The researchers noted that unmet basic needs, like financial
stability, a job, and a place to live showed up as a primary individual
barrier (in 62.5% of respondents).

- Many participants expressed having limited to no support
network (46.9%), strained relationships (43.8%), and friends who use
drugs (40.6%) as interpersonal barriers.

- One common organizational barrier was having a staff shortage
in the residential treatment programs (34.4%). There were few challenges
related to transition at community and policy levels; however, what did
come up was returning to stressful neighborhoods (31.3%) and lack of
housing available for people with only substance use problems (34.4%).

"What these results show is that the primary areas of intervention
needed for these individuals include access to stable housing and
employment, aftercare services and positive support networks; expanded
discharge planning services and transitional assistance, and funding to
address gaps in service delivery and meet individuals' basic needs,"
said Dr. Manuel "These findings suggest the importance of both informal
and formal supports to reinforce and continue progress made in
residential treatment."

The researchers' findings from this study suggest that transitions
from residential treatment are stressful, particularly as people balance
competing priorities of meeting their basic needs with managing their
addiction. Enhanced support post-discharge from residential treatment is
critical to improve the quality of transitions and outcomes of
individuals with substance use disorders.

This study is the first phase of a larger initiative to develop and
pilot test Critical Time Intervention, a transitional assistance model
for individuals leaving residential substance abuse treatment. The
study's findings are based on data that were generated from a small,
non-probability sample of mostly male individuals from a single
long-term residential substance abuse treatment program, and thus are
not representative of other individuals in long-term residential
treatment programs and their experiences.

Nevertheless, the results identify key factors to consider during
the transition from long-term residential treatment to the community,
and the findings from this study will inform future intervention
development that aims to significantly improve mid-range and long-term
outcomes among people with SUDs leaving residential treatment.

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